Clinical Characteristics, Prognosis Factors and Metagenomic Next-Generation Sequencing Diagnosis of Mucormycosis in patients With Hematologic Diseases.

IF 3.6 3区生物学 Q2 MYCOLOGY

Mycopathologia Pub Date : 2024-08-01 DOI:10.1007/s11046-024-00875-w

Jieru Wang, Li Liu, Jia Li, Xiaomeng Feng, Huiming Yi, Erlie Jiang, Yizhou Zheng, Fengkui Zhang, Xiaofan Zhu, Yingchang Mi, Mingzhe Han, Jianxiang Wang, Sizhou Feng

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引用次数: 0

Abstract

Introduction: New diagnostic methods and antifungal strategies may improve prognosis of mucormycosis. We describe the diagnostic value of metagenomic next⁃generation sequencing (mNGS) and identify the prognostic factors of mucormycosis.

Methods: We conducted a retrospective study of hematologic patients suffered from mucormycosis and treated with monotherapy [amphotericin B (AmB) or posaconazole] or combination therapy (AmB and posaconazole). The primary outcome was 84-day all-cause mortality after diagnosis.

Results: Ninety-five patients were included, with "proven" (n = 27), "probable" (n = 16) mucormycosis confirmed by traditional diagnostic methods, and "possible" (n = 52) mucormycosis with positive mNGS results. The mortality rate at 84 days was 44.2%. Possible + mNGS patients and probable patients had similar diagnosis processes, overall survival rates (44.2% vs 50.0%, p = 0.685) and overall response rates to effective drugs (44.0% vs 37.5%, p = 0.647). Furthermore, the median diagnostic time was shorter in possible + mNGS patients than proven and probable patients (14 vs 26 days, p < 0.001). Combination therapy was associated with better survival compared to monotherapy at six weeks after treatment (78.8% vs 53.1%, p = 0.0075). Multivariate analysis showed that combination therapy was the protective factor (HR = 0.338, 95% CI: 0.162-0.703, p = 0.004), though diabetes (HR = 3.864, 95% CI: 1.897-7.874, p < 0.001) and hypoxemia (HR = 3.536, 95% CI: 1.874-6.673, p < 0.001) were risk factors for mortality.

Conclusions: Mucormycosis is a life-threatening infection. Early management of diabetes and hypoxemia may improve the prognosis. Exploring effective diagnostic and treatment methods is important, and combination antifungal therapy seems to hold potential benefits.

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血液病患者粘孢子菌病的临床特征、预后因素和元基因组新一代测序诊断

导言：新的诊断方法和抗真菌策略可改善粘孢子菌病的预后。我们描述了元基因组下一代测序（mNGS）的诊断价值，并确定了粘孢子菌病的预后因素：我们对患有粘孢子菌病并接受单药治疗（两性霉素 B（AmB）或泊沙康唑）或联合治疗（AmB 和泊沙康唑）的血液病患者进行了一项回顾性研究。主要结果是确诊后 84 天的全因死亡率：结果：共纳入 95 例患者，其中经传统诊断方法确诊为 "确诊"（27 例）、"可能"（16 例）和 mNGS 结果阳性的 "可能"（52 例）粘孢子菌病。84 天的死亡率为 44.2%。可能+ mNGS 患者和可能患者的诊断过程、总体存活率（44.2% vs 50.0%，p = 0.685）和对有效药物的总体反应率（44.0% vs 37.5%，p = 0.647）相似。此外，可能+ mNGS 患者的中位诊断时间比已证实和可能的患者短（14 天 vs 26 天，p 结论：粘孢子菌病是一种危及生命的感染。早期治疗糖尿病和低氧血症可改善预后。探索有效的诊断和治疗方法非常重要，联合抗真菌疗法似乎具有潜在的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mycopathologia 生物-真菌学

CiteScore

6.80

自引率

3.60%

发文量

审稿时长

3 months

期刊介绍： Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.